Thyroid storm. A review of 22 episodes with special emphasis on the use of guanethidine

Thyroid storm as a cause of unexplained tachycardia in acutely injured trauma patients

“…14 Normal serum cortisol levels have been observed in thyroid storm under conditions of critical illness and stress where one would expect them to be elevated. 12 Nevertheless, to avoid further adrenal suppression, adjunctive corticosteroid therapy for thyroid storm should be discontinued as soon as possible once the patient's condition stabilises.…”

“…Due to its rarity, few large outcome studies of thyroid storm have been performed, but those that exist report mortality rates ranging from 20-30% even with treatment. 20,12 According to the Center for Disease Control and National Center for Health Statistics, thyroid storm accounted for 12 deaths in 2001, the most recent year of available mortality statistics. 18 As thyroid storm is rare, the average physician is unlikely to see more than one or two cases of thyroid storm during his or her career, but all clinicians should be aware of both its clinical features and its treatment to avoid unnecessary morbidity and mortality.…”

Management of Severe Thyrotoxicosis When the Gastrointestinal Tract Is Compromised

“…The use of glucocorticoids in patients with severe hyperthyroidism or thyroid storm has been shown to improve outcome (35). Glucocorticoids reduce T4-to-triodothyroinine conversion in the periphery and may have a therapeutic effect on the underlying autoimmune/inflammatory process in Graves' disease (17,36).…”

“…Glucocorticoids reduce T4-to-triodothyroinine conversion in the periphery and may have a therapeutic effect on the underlying autoimmune/inflammatory process in Graves' disease (17,36). Treatment with glucocorticoids is recommended for patients with severe thyrotoxicosis, particularly when manifesting hypotension, because of the possibility of concomitant undiagnosed adrenal insufficiency or relative insufficiency due to accelerated production and degradation owing to the hypermetabolic state (17,35,36). Further, these agents are readily available in IV form and are available to be used in such challenging clinical situations where enteral therapy is not possible.…”

How do I Diagnose and Manage Acute Endocrine Emergencies in the ICU?

“…Given the risk for coexisting adrenal insufficiency, it has become standard practice to treat severe thyrotoxicosis with glucocorticoids, and even with "normal" cortisol level, steroid therapy may improve survival. 59,60 In addition to their effects on thyroid hormone formation and release, both PTU and iopanoic acid decrease the peripheral deiodination of T 4 to T 3 . Cholestyramine also can reduce circulating thyroid hormone by inhibiting binding hormone secreted into the gastrointestinal tract and inhibiting enterohepatic recirculation.…”